Clinical Medicine & Research最新文献

Objective: Burnout syndrome is common in physicians, but little is known about burnout in lung transplant physicians specifically. The purpose of this study was to explore burnout and its relationship to job factors and depression in lung transplant physicians.Design: A cross-sectional study that included lung transplant pulmonologists and surgeons was performed via electronic survey.Setting: The lung transplant physicians surveyed practiced worldwide.Methods: The survey incorporated questions about demographics and job characteristics as well as the Maslach Burnout Inventory and Patient Health Questionnaire-2. Burnout was defined by high emotional exhaustion or depersonalization.Participants: Ninety physicians worldwide completed the survey.Results: Of the 90 physicians who completed the entire survey, 44 (48.9%) had burnout with 38 (42.2%) having high emotional exhaustion, 15 (16.7%) having high depersonalization, and 9 (10.0%) with both. Of the respondents, 14 (15.6%) had high risk of depression, and of these, 13 also had high emotional exhaustion. There was a positive correlation between depression score and emotional exhaustion score (P=0.67, P<0.001). Depression was more common in surgeons compared with pulmonologists (35.7% versus 11.8%, P=0.02). There was a trend toward more burnout by emotional exhaustion in physicians with more versus less work experience (68.4% versus 31.6%, P=0.056).Conclusions: Emotional exhaustion is common in lung transplant physicians and is associated with depression and a negative impact on life.

Humeral fractures in arm wrestling are rarely reported entities in the orthopedic literature and can present with significant pain and debilitation. These injuries are even more uncommon in female practitioners of the sport. Rotational forces applied to the humerus during competition can result in the transmission of stress into the distal part of the humerus, thereby causing a spiral fracture. Common complications that can arise from such an injury can include radial nerve palsy and butterfly fragments of the humerus. These can occur in arm wrestling and can present with prominent pain, weakness, and functional impairment. Treatment often varies according to the presenting case and are often operative in cases with displaced fractures, and non-operative in those of nondisplaced fractures. Prognostic outcomes are often favorable and uneventful. In this article, we explore a distal humeral fracture in a female arm wrestler and discuss the mechanism, presentation, and management of such an injury, based on a thorough yet concise review of literature.

Objective: We aimed to investigate preoperative esketamine alleviating postoperative pain in children after endoscopic plasma total adenotonsillectomy.Methods: We recruited 200 children with adenotonsillar hypertrophy at Wuhan Children's Hospital between September 2021 and April 2022. The children were randomly assigned to receive preoperative esketamine (ESK group) or fentanyl (FEN group). The primary endpoint was serum c-fos and c-jun levels. The secondary endpoints were face, legs, activity, cry, and consolability (FLACC) score and adverse events.Results: After surgery, c-fos and c-jun mRNA levels were increased significantly in both groups. Postoperatively, c-fos and c-jun mRNA levels were higher in FEN group compared with the ESK group (P<0.05). The FLACC scores were higher in the FEN group compared with the ESK group at 1 and 24 hours after surgery (P<0.05). Prediction probability (P_k) values indicated that c-fos and c-jun mRNA levels were quantitative predictors for early postoperative pain and stress reaction after surgery.Conclusions: Esketamine-based anesthesia (1mg/kg) can alleviate postoperative pain and regulate the inflammatory reaction in children undergoing endoscopic plasma adenotonsillectomy.

Background: In patients with ST-elevation myocardial infarction, immediate coronary angiography and intervention is the best practice, if an experienced laboratory is available. In non-Q-wave infarction most, but not all, studies suggest that early invasive strategy is superior to conservative management. Complete revascularization is preferred.Methods: A literature search regarding management of coronary artery disease was conducted in PubMed between January 1985 to January 2021. Articles published in English were reviewed, and those relevant were selected by both authors. Special focus was on the ISCHEMIA trial and related articles.Results: The utility of coronary angiography in patients with stable coronary artery disease is challenging. All patients should undergo optimal medical therapy. Patients with angina should not only receive approved anti-anginal agents but should also receive lifestyle modifications and pharmacologic therapy to control risk factors such as diabetes, hypertension, dyslipidemia, and smoking; and should consider organized physical activity programs. Low density lipoprotein should be reduced to 70 mg/dL or less. Non-invasive studies such as coronary computed tomography angiography (CCTA) are preferred. If expert CCTA is not available, then stress test, preferably with imaging, is recommended. If the results of CCTA show high risk, then coronary angiography and intervention are usually indicated. In patients with left main disease, left ventricular dysfunction, or symptoms of congestive heart failure, early invasive strategy is recommended. If none of these conditions exist, then initial medical therapy may be initiated, and invasive therapy should be utilized only if clinically indicated. In patients with chronic stable angina, continue with medical therapy and risk factor modification. If the frequency or severity of angina episodes change, coronary angiography and revascularization should be considered, as appropriate. In patients with significant renal dysfunction, angiogram may be indicated only if there is complete failure of medical therapy.Conclusion: Optimal medical therapy should be initially utilized in all patients. Early invasive management and revascularization should be utilized in patients with left ventricular dysfunction, congestive heart failure, and failure of medical therapy. A shared decision-making process should always be utilized.

Background: Hyperuricemia is associated with several risk factors for mortality and severe coronavirus disease 2019 (COVID-19) manifestations.Objective: The objective of this research was to examine whether hyperuricemia is a risk factor for mortality and other adverse outcomes in patients hospitalized for COVID-19.Design: This is a retrospective review of patients hospitalized for COVID-19 between March 15 and November 30, 2020, with available uric acid (UA) levels.Results: Among 1566 patients who were hospitalized during the study period, 222 patients had an available UA level. The mean age ± standard deviation (SD) was 56.5 ± 19.5 years. The mean ± SD for UA (mg/dL) among the total cohort was 5.65 ± 2.18, and 21.2% of the total study population had hyperuricemia (UA > 7 mg/dL) on admission. The mortality rate was 14.4%, and mortality was associated with higher UA levels on admission (6.9 ± 2.6 mg/dL vs. 5.5 ± 2 mg/dL in patients who survived, P < 0.05). Patients who needed intensive oxygen support (high-flow nasal cannula or mechanical ventilation) and those who required longer-than-average hospitalization (> 7 days) had more hyperuricemia (intensive oxygen support: 30% vs. 18%, P = 0.07; long hospitalization 29% vs. 16.2%, P < 0.05).Conclusion: Our findings show that high UA levels are associated with adverse outcomes in patients hospitalized for COVID-19. We suggest evaluating hyperuricemia as a marker that integrates and reflects both poor prognostic baseline characteristics and acute components such as inflammatory state, hypovolemic state, and renal failure.

Objective: To investigate the pattern and prevalence of persistent symptoms of Post-COVID-19 Syndrome (PCS) at 3, 6, 9, and 18 months after discharge. Associated risk factors were further examined to potentially explain the persistence of these symptoms.Design and Setting: A cross-sectional cohort study was conducted at the primary health care facility of Aruba, Dr. Horacio E. Oduber Hospital (HOH).Participants: Inclusion criteria were adults hospitalized at HOH for at least one night between March and July 2021 and laboratory-confirmed COVID-19 diagnosis. Exclusion criteria were deceased before the follow-up, not able to mobilize before or after discharge, living outside of Aruba or in nursing homes, and patients with psychosis, dementia, or hospitalized due to unrelated diseases.Methods: Eligible and willing participants completed a 20-question survey: a self-reported symptoms questionnaire about symptoms during and after COVID-19 infection, level of dyspnea measurement (mMRC-scale), quality of life measurement (EQ-5D-5E with EuroQoL VAS), and mental well-being (WHO-5). Hospitalization related data were gathered via retrospective analysis of patient records. Chi-square test, logistic regression, and ANOVA analyses were conducted; P<0.05 was chosen as level of statistical significance for all analyses.Results: In total, 222 (34.5%) patients were eligible, consenting, and completed the survey. Most participants were interviewed a year or more after their initial COVID-19 infection. Fatigue (37.8%), new-onset dyspnea (38.7%), hair loss (20.3%), and muscle pain (18.0%) were the most frequently reported symptoms at any time post COVID-19 infection. Female participants were found more likely to experience fatigue (P<0.05, OR 2.135, 95% CI 1.154-3.949) and new-onset dyspnea (P<0.05, OR 2.026 95% CI 1.093-3.756) after initial infection. Participants with one or more respiratory comorbidity were more likely to experience new-onset dyspnea (P<0.05, OR 2.681, 95% CI 1.223-5.873). None of the predictor variables was associated with cognitive impairment.Conclusion: This study identified female sex and respiratory comorbidity as crucial risk factors for PCS. Females were also found to have significantly lower health scores. Female participants were more likely to experience fatigue and dyspnea after COVID-19 infection.